Varicose veins are blood vessels that have become twisted and swollen when their one-way valves are compromised or when the vein wall weakens. Spider veins are those thin networks of vessels that appear on the skin. As people grow older, the likelihood of having large and/or smaller varicose and spider veins increases. In fact, varicose and spider veins affect over half the population by age 55 and are linked to factors such as heredity, pregnancy, estrogen medications, prolonged standing or sitting, sedentary lifestyle, and injury to the legs. Left untreated, varicose veins can cause pain, swelling, phlebitis, chronic skin ulcers, and potentially life-threatening blood clots.
Spider veins often appear on the skin of the lower extremities. These are abnormally dilated segments of the normal network of small veins in the skin. There is a significant genetic or hereditary predisposition to developing these abnormal vessels. In addition, progesterone stimulates the development of these abnormal veins. As a result these are more commonly seen in women, and may develop in association with pregnancy. Spider veins, although not usually symptomatic, occasionally they can be painful.
Though often benign, many individuals desire treatment of spider veins because of their appearance. Sclerotherapy, laser and intense-pulsed-light therapy, radio-frequency ablation, and medical extirpation are the techniques typically used to ablate varicosities.
During sclerotherapy a sclerosing agent such as polidocanol or hypertonic sodium chloride is injected in the dilated vein. A high degree of skill is required for this procedure. The treatment is ineffective in cases where a deeper aberrant vein is missed. Further, the technique has significant morbidity in cases where the agent extravasates outside the blood vessel. Microsclerotherapy is a type of sclerotherapy that uses improved solutions and injection techniques that increase the success rate for removal of spider veins.
In one type of ablation procedure, the surgeon inserts a very thin catheter into the enlarged vein and applies heat through the tip of the catheter. When the catheter is withdrawn, the heat causes the vein to collapse and the blood to reroute through healthier veins. Catheter assisted methods can use radio waves or lasers to close the main vein or a mechanical blade to remove the branch varicose veins.